For the first time, it is possible to directly visualize a radiation beam hitting a patient's tissue or high resolution imaging of radiation delivery in water tank phantoms, using Cerenkov emission imaging. This allows the opportunity to do pre-treatment verification at high resolution, on-patient verification of every delivered fraction, or simply monitoring for the therapists to see what is happening in the room. In a field where there is an incredibly high number of new technologies for delivery, the verification of delivery and recording of adverse incidents will become more and more important. Yet tools to assess these incidents and verify delivery must become easier to use so as not to overburden the system. A recent discovery that gated intensified imaging allows video-rate detection of Cherenkov emission during radiation therapy has opened up a new important paradigm in radiation oncology verification. This work has been invented and patented at Dartmouth, and DoseOptics LLC is a company spin-off of this research program, with the goal to advance video-rate Cerenkov imaging as a dose delivery visualization & verification tool. The alpha prototype developed in this first phase 1 application will be a C-IMRT/VMAT verification tool for water tank imaging. The system will be developed with a unique proprietary moderate cost design, which will then be tested in phantoms and with patient treatment plans delivered to water tanks. The system will have capabilities for video-rate capture of IMRT/VMAT data, tracking MLC movements in real time, and allowing analysis of treatment plans on a beam to beam basis. The competing technologies using ionization chambers or diode arrays are low resolution devices with limitations that they cannot eventually translate to direct on patient imaging. The work carried out in the company is augmented by a plan to evaluate the system in Clinical Physics at Dartmouth, and be further evaluated at Stanford and UPenn. The technology patent protected as developed by this group, and for this start up, the team of developers includes a substantial number of experts in Cerenkov imaging, medical physics and new venture creation.